“Only Time Will Tell”: The Underexplored Impacts of Lead Poisoning and COVID-19 on Pre-Existing ACEs in New York

Round 1

Reviewer 1 Report

This manuscript is timely and addresses a public health issue of concern. 

However, I have a few comments following my observations:

1. Re-read through the manuscript and replace instances of NYSHA with NYCHA

2. Include the aim in the body of the manuscript and not only in the abstract.

3. The title is too long and even reads as incomplete on my end. The title I have ends with the following phrase "Implications For A Two-Hit Hypothesis Amongst 3 A Pre-existing Array of Adverse Childhood Experiences That", maybe the word 'that' should be deleted.

4. In the second paragraph, reference 23 which you base your argument of the two points that compound geographic lead risks in the NYCHA population does not make mention of NYCHA. It is advisable to identify a more direct reference to use for this point. 

5. The two-hit hypothesis that you are proposing might not be wholly applicable in this case because of the duration of COVID-19. If the pandemic was still ongoing with the intensity of 2020 without the vaccine, I would agree. Furthermore, in making a case for the two-hit hypothesis you do not share the prevalence of pediatric COVID-19 in this population of interest. We make logically assumptions that lead risks increased during lockdown. This will not be true if the schools/daycares that children attend also have lead in them. 

6. Generally, throughout the manuscripts several statements are made that are factual without evidence. 

 

Author Response

We spoke with Janice Bi from the management group from MDPI to obtain an extension to re-submit a revised manuscript (ID: YOUTH-24065650) an original short communication for the Special Issue of ‘Youth.’ “Studying the New ‘ACEs’: Adverse COVID Experiences among Vulnerable Youth.” Our manuscript titled “The Underexplored Impacts of Lead Poisoning And COVID-19 in New York: Implications For A Two-Hit Hypothesis Amongst A Pre-Existing Array of Adverse Childhood Experiences That Only Time Will Tell” highlights a concerning issue of the children residing in New York City Housing Authority (NYCHA) residences and their inability to escape the challenging of adverse childhood experiences (ACEs) and COVID-19. We have addressed the reviewer’s comments below in red font and highlighted in yellow and in red font within the revised manuscript.

 

Reviewer #1 Comments:

 

• Re-read through the manuscript and replace instances of NYSHA with NYCHA.

 

We have made these corrections and thank the reviewers for catching this oversight in two sentences.

 

• Include the aim in the body of the manuscript and not only in the abstract.

 

We thank the reviewer for noticing this and we have added a sentence on the aim of the study on within the body manuscript.

 

• The title is too long and even reads as incomplete on my end. The title I have ends with the following phrase “Implications For A Two-Hit Hypothesis Amongst 3 A Pre-existing Array of Adverse Childhood Experiences That”, maybe the word ‘that’ should be deleted.

 

We understand this reviewers comment, but this appears to be an manuscript portal issue as the full title shows on our end of the manuscript management portal, which is as follows: “The Underexplored Impacts of Lead Poisoning And COVID-19 in New York: Implications For A Two-Hit Hypothesis Amongst A Pre-Existing Array of Adverse Childhood Experiences That Only Time Will Tell”.  Thus, we can assure the reviewer that the full title is appropriate, matches the topic of the special issue, and was precisely worded to capture the attention it deserves in the field/literature to raise more awareness on the matter. Thus, there is no further changes required to address this reviewer comment.

 

• In the second paragraph, reference 23 which you base your argument of the two points that compound geographic lead risks in the NYCHA population does not make mention of NYCHA. It is advisable to identify a more direct reference to use for this point.

 

We thank the reviewer for pointing this out and we have added a set of stronger references 24-33 to support our positional argument to further complement reference 23. We have also added Figure 1 to support the references.

 

• The two-hit hypothesis that you are proposing might not be wholly applicable in this case because of the duration of COVID-19. If the pandemic was still ongoing with the intensity of 2020 without vaccine, I would agree. Furthermore, in making a case for the two-hit hypothesis you do not share the prevalence of pediatric COVID-19 in this population of interest. We make logically assumptions that lead risks increased during lockdown. This will not be true if the schools/daycares that children attend also have lead in them.

We appreciate the reviewers comments, but we would have to disagree. The COVID-19 pandemic is still occurring, people are still being negatively impacted, although the death tolls have not returned to levels at the beginning of the pandemic, long COVID-19 symptoms and other associated negative health effects still disproportionately hit low socioeconomic communities as the residents in NYCHA and they have more barriers to access health supports than other communities in the New York City areas. One report exists on adults with COVID-19 and lead exposure (see reference 104) and several others on the relationship between lead poisoning BLL screening issues due to COVID-19 (see references 93-99). From this study, it was found that there aren’t clear or transparent publicly available datasets from NYCHA or the New York State government on  children in NYCHA with lead poisoning and COVID-19 and whether the same children have tested positive for COVID-19 more than once. Moreover, the pediatric data on children with COVID-19 would not disaggregate them by NYCHA or other residential living circumstances. Although, we agree with the reviewer that this would be the best way to resolve the matter, this is the work that should be done by both NYCHA and the New York State public health department and is beyond our jurisdiction. Hence, this was the impetus for the short communication to raise such an awareness based on what is being reported in the literature from other researchers. Lastly, we do not understand the last comment on the schools/daycares as when the pandemic hit, everyone was in the virtual classroom, online Zoom, Cisco Webex, Google Meet, or Microsoft Teams learning formats from their own residences. Additionally, children and families in NYCHA were technology insecure (i.e., lacked laptops or desktop computers, did not have WiFi or had limited connectivity. Perhaps this issue is only fully comprehended by people who lived in New York like us, that others may not fully grasp. We added some of these contextual points into the body, discussion, and conclusion of the paper to help settle this issue and attempt to address this reviewer comment, but eliminated this sentence to facilitate the flow of the manuscript.

 

• Generally, throughout the manuscript several statements are made that are factual without evidence.

 

Without specifics, we are not clear on what the reviewers would like changed or addressed differently. However, we went through the manuscript again thoroughly and scrutinized our writing to ensure that we are making factual claims based upon the existing information in the literature available in which we added many new references to support the claims made herein.

Author Response File: Author Response.pdf

Reviewer 2 Report

I think the authors have explored a very interesting topic. 

-This study focuses on the neurodevelopmental and socioeconomic consequences of lead exposure in children infected with COVID-19 and seeks to draw attention to this public health issue.

- This study is somewhat original and attempts to draw attention to this issue by summarizing the results of previous research. But this article is more of a literature review than providing new conclusive scientific evidence to examine the adverse outcomes in children exposed to lead and infected with COVID-19.

- This paper summarized the existing literature and tried to answer the questions or hypotheses raised, but also failed to test the "two-hit" hypothesis by empirical survey or experiment.

- The article does not have a special section to introduce the research methods used in their article, so we cannot review the scientific and rational of research methods in this study.

- Article references are appropriate.

In conclusion, in my opinion, this article is more like a literature review than an empirical research paper. I have only one small suggestion, that is, the section of “Discussion” and “Conclusion” can be elaborated.

English language fine and only need minor editing.

Author Response

Reviewer # 2’s Comments:

 

• I think the authors have explored a very interesting topic. This study focuses on the neurodevelopmental and socioeconomic consequences of lead exposure in children infected with COVID-19 and seeks to draw attention to this public health issue.

 

We thank the reviewer for confirming the value that this manuscript seeks to offer the field as a short communication on an underexplored matter that deserve much attention and more research on the topic is warranted. There is nothing to address here based on the reviewers comment being one of appraisal.

 

• This study is somewhat original and attempts to draw attention the issue by summarizing the results of previous research. But this article is more of a literature review than providing new conclusive scientific evidence to examine the adverse outcomes in children exposed to lead and infected with COVID-19.

 

We thank the reviewer for their comment. This manuscript was developed as a short communication to draw more attention to this underexplored and overlooked matter. Yes, ample research is cited as in the childhood lead poisoning literature, which was used to provide a sufficient context in an effort to raise awareness to these timely public health concerns. The very nature that the datasets on these populations are not clear, transparent, and publicly available motivated us as authors concerned that these children in NYCHA are being overlooked and bypassed. Further, this has made us as authors conceive of this as a two-hit hypothesis negatively affecting children between lead exposures and COVID-19 as reconceptualized Adverse Childhood Experiences-19 (ACEs-19). In the absences of concrete datasets from the government, NYCHA, and the literature, this short communication serves to stimulate pediatric, public health, and government researchers to interrogate this hypothesis to confirm or disconfirm it. Thus, we have no additional datasets to add more conclusive information as none presently exist (see updated Methods section for review) and NYCHA has not put out any such reports.

 

• This paper summarized the existing literature and tried to answer the questions of hypotheses raised, but also failed to test the “two-hit” hypothesis by empirical survey or experiment.

 

We appreciate the reviewers insight here, but this ask goes well-beyond the scope of the short communication and is beyond our capacity to conduct such a study. We fully agree that such a study should be conducted, but that would be within the jurisdiction of the NYCHA and other New York State government public health officials as this would require logistical and ethical considerations as the anonymity of children and their families surveyed responses may be compromised/jeopardized as they live in public housing. Thus, we disagree with the reviewers comment that we failed to address the issue as this would be a remarkable undertaking with serious participant confidentiality concerns for any Institutional Review Board to consider if such a study were to be done by faculty at a College/University separate of NYCHA and New York State government public health officials.

 

• The articles does not have a special section to introduce the research methods used in their article, so we cannot review the scientific and rational of research methods in this study.

 

We thank the reviewer for this comment. We have now offered a methods section to this short communication.

 

• Article references are appropriate.

 

We thank the reviewer for this positive comment on the references we used. There is nothing further to address here.

 

• In conclusion, in my opinion, this article is more like a literature review than an empirical research paper. I have only one small suggestion, that is, the section of “Discussion” and “conclusion” can be elaborated.

 

We thank the reviewer for this comment. However, again we stress here that this is a short communication and not a literature review as this manuscript is 5-pages of text with the remainder comprising references. Thus, no literature review could be effectively done in 5-pages and we apologize if the reviewer missed the type of manuscript that this was submitted as for this special issue. However, we did take the reviewer’s suggestion to elaborate more on the discussion and conclusion section and we have done so accordingly.

 

We thank the reviewers for their feedback, which we believe has strengthened this manuscript as a short communication and not a literature review or a full empirical study. We are certain that you will find the revision of this short communication to meet the requirements of publication and to also complement this special issue. We look forward to your decision as Editor of this special issue.

Author Response File: Author Response.pdf